Angiolymphoid hyperplasia with eosinophilia

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| synonyms = Epithelioid hemangioma

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| caption = Angiolymphoid hyperplasia with eosinophilia

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Angiolymphoid hyperplasia with eosinophilia (also known as:{{cite book |author=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |isbn=978-1-4160-2999-1 }} "Epithelioid hemangioma," "Histiocytoid hemangioma," "Inflammatory angiomatous nodule," "Intravenous atypical vascular proliferation," "Papular angioplasia," "Inflammatory arteriovenous hemangioma," and "Pseudopyogenic granuloma") usually presents with pink to red-brown, dome-shaped, dermal papules or nodules of the head or neck, especially about the ears and on the scalp.James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. {{ISBN|0-7216-2921-0}}.

It, or a similar lesion, has been suggested as a feature of IgG4-related skin disease, which is the name used for skin manifestations of IgG4-related disease.

{{cite journal |author1=Yoshiki Tokura |author2=Hiroaki Yagi |author3=H. Yanaguchi |author4=Yuta Majima |author5=Akira Kasuya |author6=Taisuke Ito |author7=M Maekawa |author8=Hideo Hashizume |date=November 2014 |title=IgG4-related skin disease |journal=British Journal of Dermatology |volume=171 |issue=5 |pages=959–967 |doi=10.1111/bjd.13296 |pmid=25065694|s2cid=5374017 }}

{{cite journal |author1=Yasuhito Hamaguchi |author2=Manabu Fujimoto |author3=Yukiyo Matsushita |author4=Seiko Kitamura-Sawada |author5=Mitsuhiro Kawano |author6=Kazuhiko Takehara |date=2011 |title=IgG4-related skin disease, a mimic of angiolymphoid hyperplasia with eosinophilia |journal=Dermatology |volume=223 |issue=4 |pages=301–305 |doi=10.1159/000335372 |pmid=22269779|s2cid=22928854 }}

Signs and symptoms

Angiolymphoid hyperplasia with eosinophilia is characterized by papulonodular lesions on the head and neck that are violaceous or erythematous.{{cite journal | last1=Nogueira | first1=Andreia | last2=Accioly Filho | first2=José Wilson | last3=Castro | first3=Maria Cristina Ribeiro de | last4=Maceira | first4=Juan Piñero | last5=Ramos-e-Silva | first5=Marcia | title=Hiperplasia angiolinfóide com eosinofilia: relato de dois casos | journal=Anais Brasileiros de Dermatologia | publisher=FapUNIFESP (SciELO) | volume=78 | issue=1 | year=2003 | issn=0365-0596 | doi=10.1590/s0365-05962003000100008 | pages=79–85| doi-access=free }} Lesions on the genital area, upper limbs, and trunk are uncommon. The lesions could be painful, pruriginous, or asymptomatic. Peripheral eosinophilia and lymphadenomegaly could be present.{{cite journal | last1=Esteves | first1=Paola | last2=Barbalho | first2=Marcella | last3=Lima | first3=Tiago | last4=Quintella | first4=Leonardo | last5=Niemeyer-Corbellini | first5=João Paulo | last6=Ramos-e-Silva | first6=Marcia | title=Angiolymphoid Hyperplasia with Eosinophilia: A Case Report | journal=Case Reports in Dermatology | publisher=S. Karger AG | volume=7 | issue=2 | date=May 29, 2015 | issn=1662-6567 | doi=10.1159/000381843 | pages=113–116| pmid=26120306 | pmc=4478319 }}

Causes

Currently, the cause of angiolymphoid hyperplasia with eosinophilia is unknown. Several theories have been proposed, but none of them have proven to be conclusive or definitive. These include reactive processes, neoplastic processes, and infectious mechanisms that may be connected to the human immunodeficiency virus.{{cite journal | last1=Guo | first1=Ruifeng | last2=Gavino | first2=Alde Carlo P. | title=Angiolymphoid Hyperplasia With Eosinophilia | journal=Archives of Pathology & Laboratory Medicine | volume=139 | issue=5 | date=May 1, 2015 | issn=1543-2165 | doi=10.5858/arpa.2013-0334-rs | pages=683–686| pmid=25927152 }}

Though its significance in the etiology of angiolymphoid hyperplasia with eosinophilia remains unclear, the distinctive inflammatory infiltrate in angiolymphoid hyperplasia with eosinophilia seems to be a crucial aspect of this illness. Vascular proliferation may be explained by the endothelial cells' response to proliferative stimuli produced by the inflammatory cells and immunologic allergic reaction that surround them.{{cite journal | last1=Olsen | first1=Thomas G. | last2=Helwig | first2=Elson B. | title=Angiolymphoid hyperplasia with eosinophilia | journal=Journal of the American Academy of Dermatology | publisher=Elsevier BV | volume=12 | issue=5 | year=1985 | issn=0190-9622 | doi=10.1016/s0190-9622(85)70098-9 | pages=781–796| pmid=4008683 }}{{cite journal | last1=Stewart | first1=Nicholas | last2=Zagarella | first2=Samuel | last3=Mann | first3=Steve | title=Angiolyphoid hyperplasia with eosinophilia occurring after venipuncture trauma | journal=The Journal of Dermatology | volume=40 | issue=5 | date=2013 | issn=0385-2407 | doi=10.1111/1346-8138.12106 | pages=393–395| pmid=23488565 | s2cid=20965967 }} Elevated serum estrogen levels,{{cite journal | last=Moy | first=Ronald L. | title=Estrogen Receptors and the Response to Sex Hormones in Angiolymphoid Hyperplasia With Eosinophilia | journal=Archives of Dermatology | volume=128 | issue=6 | date=1992-06-01 | pages=825–828 | issn=0003-987X | doi=10.1001/archderm.1992.01680160109016 | pmid=1599273 }} local trauma,{{cite journal |last1=Fetsch |first1=J F |last2=Weiss |first2=S W |title=Observations concerning the pathogenesis of epithelioid hemangioma (angiolymphoid hyperplasia) |journal=Modern Pathology |date=July 1991 |volume=4 |issue=4 |pages=449–455 |pmid=1924276}} and arteriovenous shunting{{cite journal | last=Moesner | first=Jørgen | title=Angiolymphoid Hyperplasia With Eosinophilia (Kimura's Disease): A Case With Dermal Lesions in the Knee Region and a Popliteal Arteriovenous Fistula | journal=Archives of Dermatology | volume=117 | issue=10 | date=1981-10-01 | pages=650–653 | issn=0003-987X | doi=10.1001/archderm.1981.01650100052028 | pmid=7283457 }} are most likely contributing factors.

The TEK gene, which codes for the endothelial cell tyrosine kinase receptor Tie-2, was found to contain a mutation in a case of dermal angiolymphoid hyperplasia with eosinophilia, suggesting that specific molecular changes may play a role in the pathophysiology of this condition.{{cite journal | last1=Ye | first1=Caisheng | last2=Pan | first2=Lingxiao | last3=Huang | first3=Yongbo | last4=Ye | first4=Runyi | last5=Han | first5=Anjia | last6=Li | first6=Songqi | last7=Li | first7=Xiaoxi | last8=Wang | first8=Shenming | title=Somatic mutations in exon 17 of the TEK gene in vascular tumors and vascular malformations | journal=Journal of Vascular Surgery | publisher=Elsevier BV | volume=54 | issue=6 | year=2011 | issn=0741-5214 | doi=10.1016/j.jvs.2011.06.098 | pages=1760–1768.e3| pmid=21962923 | doi-access=free }}

While angiolymphoid hyperplasia with eosinophilia is thought to be a benign tumefaction, it has been linked to a number of lymphoproliferative disorders, which lends credence to the argument put forth by some that angiolymphoid hyperplasia with eosinophilia could occasionally be a monoclonal T-cell process.{{cite journal | last1=Kempf | first1=Werner | last2=Haeffner | first2=Andreas C. | last3=Zepter | first3=Karoline | last4=Sander | first4=Christian A. | last5=Flaig | first5=Michael J. | last6=Mueller | first6=Beatrix | last7=Panizzon | first7=Renato G. | last8=Hardmeier | first8=Thomas | last9=Adams | first9=Volker | last10=Burg | first10=Günter | title=Angiolymphoid hyperplasia with eosinophilia: Evidence for a T-cell lymphoproliferative origin | journal=Human Pathology | publisher=Elsevier BV | volume=33 | issue=10 | year=2002 | issn=0046-8177 | doi=10.1053/hupa.2002.128247 | pages=1023–1029| pmid=12395376 }}{{cite journal | last1=Gonzalez-Cuyar | first1=Luis F | last2=Tavora | first2=Fabio | last3=Zhao | first3=X Frank | last4=Wang | first4=Guanghua | last5=Auerbach | first5=Aaron | last6=Aguilera | first6=Nadine | last7=Burke | first7=Allen P | title=Angiolymphoid hyperplasia with eosinophilia developing in a patient with history of peripheral T-cell lymphoma: evidence for multicentric T-cell lymphoproliferative process | journal=Diagnostic Pathology | volume=3 | issue=1 | date=2008 | issn=1746-1596 | pmid=18510751 | pmc=2427016 | doi=10.1186/1746-1596-3-22 | doi-access=free | page=22}} Follic mucinosis was found to be present concurrently in a small number of angiolymphoid hyperplasia with eosinophilia cases.{{cite journal | last=Joshi | first=Rajiv | title=Angiolymphoid hyperplasia with follicular mucinosis | journal=Indian Journal of Dermatology, Venereology and Leprology | publisher=Scientific Scholar | volume=73 | issue=5 | year=2007 | pages=346–347 | issn=0378-6323 | doi=10.4103/0378-6323.35739 | doi-access=free | pmid=17921619 }} A clear correlation between angiolymphoid hyperplasia with eosinophilia and mycosis fungoides has not yet been documented, and this association is fairly ambiguous. Remarkably, a patient with angiolymphoid hyperplasia with eosinophilia has been documented to develop peripheral T-cell lymphoma.{{cite journal | last1=Andreae | first1=J. | last2=Galle | first2=C. | last3=Magdorf | first3=K. | last4=Staab | first4=D. | last5=Meyer | first5=L. | last6=Goldman | first6=M. | last7=Querfeld | first7=U. | title=Severe atherosclerosis of the aorta and development of peripheral T-cell lymphoma in an adolescent with angiolymphoid hyperplasia with eosinophilia | journal=British Journal of Dermatology | volume=152 | issue=5 | date=2005 | issn=0007-0963 | doi=10.1111/j.1365-2133.2005.06421.x | pages=1033–1038| pmid=15888166 | s2cid=7040587 }} T-cell receptor gene (TCR) rearrangement and monoclonality have also been found in angiolymphoid hyperplasia with eosinophilia cases. The same monoclonal TCR gene rearrangement was found in both lesions in a patient, who had both peripheral T-cell lymphoma and angiolymphoid hyperplasia with eosinophilia.

Diagnosis

A complete blood count, which is part of the laboratory analysis, indicates peripheral blood eosinophilia in about 20% of the cases.

To make the diagnosis, a biopsy of the lesions is needed. Strong reactivity for CD31 and lower reactivity for CD34 and factor VIII-related antigen is shown by an immunohistochemical analysis.{{cite journal | last1=Fetsch | first1=John F | last2=Sesterhenn | first2=Isabell A | last3=Miettinen | first3=Markku | last4=Davis | first4=Charles J | title=Epithelioid Hemangioma of the Penis | journal=The American Journal of Surgical Pathology | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=28 | issue=4 | year=2004 | issn=0147-5185 | doi=10.1097/00000478-200404000-00012 | pages=523–533| pmid=15087672 | s2cid=33137366 }}

When angiolymphoid hyperplasia with eosinophilia lesions are examined under a microscope, a polymorphous vascular pattern made up of uniformly spaced linear and dotted vessels is visible over a background that ranges in color from pink to red.{{cite journal | last1=Rodríguez-Lomba | first1=Enrique | last2=Avilés-Izquierdo | first2=Jose Antonio | last3=Molina-López | first3=Irene | last4=Parra-Blanco | first4=Verónica | last5=Lázaro-Ochaita | first5=Pablo | last6=Suárez-Fernández | first6=Ricardo | title=Dermoscopic features in 2 cases of angiolymphoid hyperplasia with eosinophilia | journal=Journal of the American Academy of Dermatology | publisher=Elsevier BV | volume=75 | issue=1 | year=2016 | issn=0190-9622 | doi=10.1016/j.jaad.2016.02.1145 | pages=e19–e21| pmid=27317536 }}

Treatment

The preferred course of treatment is surgical excision; after being fully removed, angiolymphoid hyperplasia with eosinophilia rarely returns.{{cite journal | last1=Baghestani | first1=Shahram | last2=Firooz | first2=Alireza | last3=Ghazisaidi | first3=Mohammad Reza | title=A refractory case of angiolymphoid hyperplasia with eosinophilia successfully treated by surgery | journal=Journal of Dermatological Treatment | volume=22 | issue=1 | date=2011-02-01 | issn=0954-6634 | doi=10.3109/09546630903440072 | pages=49–51| pmid=20524877 | s2cid=30142901 }} Other treatments include cryosurgery,{{cite journal | last1=Caca-Biljanovska | first1=Nina | last2=Arsovska-Bezhoska | first2=Irina | title=Angiolymphoid Hyperplasia with Eosinophilia Successfully Treated with Cryotherapy | journal=Open Access Macedonian Journal of Medical Sciences | publisher=Scientific Foundation SPIROSKI | volume=7 | issue=5 | date=2019-03-03 | pages=794–796 | pmid=30962842 | doi=10.3889/oamjms.2019.110 | doi-broken-date=1 December 2024 | pmc=6447327 }} carbon dioxide laser,{{cite journal | last1=Kaur | first1=T | last2=Sandhu | first2=K | last3=Gupta | first3=S | last4=Kanwar | first4=Aj | last5=Kumar | first5=B | title=Treatment of angiolymphoid hyperplasia with eosinophilia with the carbon dioxide laser | journal=Journal of Dermatological Treatment | volume=15 | issue=5 | date=2004-09-01 | issn=0954-6634 | doi=10.1080/09546630410015547 | pages=328–330| pmid=15370402 | s2cid=36522330 }} pulsed-dye laser,{{cite journal | last1=Abrahamson | first1=Timothy G | last2=Davis | first2=David A | title=Angiolymphoid hyperplasia with eosinophilia responsive to pulsed dye laser | journal=Journal of the American Academy of Dermatology | publisher=Elsevier BV | volume=49 | issue=2 | year=2003 | issn=0190-9622 | doi=10.1067/mjd.2003.314 | pages=195–196| pmid=12894122 }} and Mohs micrographic surgery.{{cite journal | last1=Miller | first1=Christopher J. | last2=Ioffreda | first2=Michael D. | last3=Ammirati | first3=Christie T. | title=Mohs Micrographic Surgery for Angiolymphoid Hyperplasia with Eosinophilia | journal=Dermatologic Surgery | volume=30 | issue=8 | date=2004 | issn=1076-0512 | doi=10.1111/j.1524-4725.2004.30349.x | pages=1169–1173| pmid=15274714 | s2cid=37140412 }}

References

External links

[https://dermnetnz.org/topics/angiolymphoid-hyperplasia-with-eosinophilia DermNet]
[https://www.ncbi.nlm.nih.gov/books/NBK538181/ StatPearls]

{{Medical resources

| ICD11 = {{ICD11|2F2Y}}

| ICD10 = {{ICD10|L98.8}} (ILDS L98.812)

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| MeshID = D000796

| DiseasesDB = 31380

| SNOMED CT = 125574005

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Category:Vascular anomalies

Category:Eosinophilic cutaneous conditions

Category:IgG4-related disease